- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.83 / $16.80 / $21.58
| Facility | | $14.83 | $16.80 | $21.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.17 / $16.17 / $16.17
| Professional | | $16.17 | $16.17 | $16.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.33 / $21.58 / $21.58
| Professional | | $14.33 | $21.58 | $21.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.21 / $38.53 / $45.08
| Professional | | $29.21 | $38.53 | $45.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $21.58 / $26.97
| Professional | | $17.98 | $21.58 | $26.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.55 / $21.58 / $34.90
| Professional | | $7.55 | $21.58 | $34.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.14 / $32.40 / $45.22
| Professional | | $20.14 | $32.40 | $45.22 |